Bilateral Multiple Herpetic Epithelial Keratitis: A Case Report and Review of the Literature.

Herpetic epithelial keratitis is a viral infection of the cornea caused by the herpes simplex virus (HSV). It typically presents as a unilateral disease. Bilateral involvement is a rare manifestation of herpetic epithelial keratitis, accounting for only a small percentage of cases. By sharing this case, we aim to contribute to the understanding of bilateral herpetic epithelial keratitis and stimulate further research in this area to optimize patient care and outcomes A 13-year-old child, a known case of atopy, presented to the ophthalmology clinic with a complaint of pain, photophobia, and redness in the right eye (OD) for three days. The patient was diagnosed as a case of bilateral herpetic epithelial keratitis; he was started on moxifloxacin eye drops four times a day, Artelac (sodium hyaluronate) every two hours, carbomer HS, ganciclovir ointment five times per day. Bilateral herpetic epithelial keratitis is a rare manifestation of HSV infection, and its management poses unique challenges compared to unilateral disease. The diagnosis of bilateral herpetic epithelial keratitis is primarily based on clinical findings, including bilateral dendritic or geographic ulcers on the cornea. Fluorescein staining is a valuable tool for visualizing corneal ulcers. In our case, the presence of bilateral dendritic ulcers in the absence of significant anterior chamber inflammation supported the diagnosis of bilateral herpetic epithelial keratitis Despite the limited literature on bilateral herpetic epithelial keratitis, the principles of management remain consistent with those of unilateral disease. Early recognition, prompt initiation of antiviral therapy, and close follow-up are crucial for successful outcomes.

Community-Level Awareness of Proper Immediate Steps Regarding Ocular Chemical Injury in Qassim Region, Saudi Arabia.

Background An ocular chemical injury is a critical medical condition that results in harm to many components within the orbit, including the epithelium, cornea, and anterior segment. Most accidents tend to transpire among individuals in younger age groups, primarily as a result of their exposure to hazardous conditions either within their domestic environment or in occupational settings. Objective The objective of this study is to evaluate the extent of community awareness of chemical eye injuries and the appropriate measures for urgent care, focusing on different age groups within the Al-Qassim region. Methods A cross-sectional study was utilized in this research, employing data from a sample of 384 individuals residing in Qassim. The participants completed a self-administered questionnaire, which was administered online and ensured anonymity. The questionnaire used in this study had been previously validated. Results The study included a total of 384 participants who were not affiliated with the medical field, selected from the Al-Qassim region. Most of the respondents demonstrated fairly good level of awareness regarding ocular chemical injury (69%). There was a statistically significant relationship between age and the level of awareness (p-value=0.00001<0.05). Most participants believed that ocular chemical injury could cause ocular complications (93.8%) and identified chloride and detergents (92.2%) as the main materials that cause ocular injuries. Conclusion Overall summary, this study's findings suggest that there exists a moderate degree of knowledge among the public regarding chemical injuries to the eye and the appropriate rapid response to such injuries. Majority of the community members were aware that ocular chemical injury can cause ocular complications, blindness, perforation, scarring, and cataracts. Additionally, chloride and detergents were found to be the most common causes of ocular injuries among the population. The study found the most common immediate action when exposed to ocular chemical injury was to irrigate the eye with large amount of water. The study established a statistically significant association between the age and awareness about ocular chemical injury; thus, age appears to be a key factor influencing the amount of awareness seen.

A Rare Case of Vaginal Atresia in an Adolescent Girl Presenting With Abdominal Pain.

Vaginal atresia, an infrequent congenital anomaly characterized by the absence or underdevelopment of the vaginal canal, presents significant complexities in pediatric and adolescent gynecological practice. Its diverse range of clinical presentations, including primary amenorrhea and cyclic abdominal discomfort, creates diagnostic challenges, highlighting the need for timely intervention to relieve symptoms and preserve future reproductive health. This case underscores the essential role of a collaborative, multidisciplinary approach involving pediatricians, gynecologists, and surgeons in ensuring comprehensive care and optimizing patient outcomes. In this report, we present the case of a 10-year-old female who initially presented with chronic abdominal pain, which had been occurring intermittently over the course of several months. This ultimately led to the diagnosis of hematometra secondary to vaginal atresia. Utilizing magnetic resonance imaging, we confirmed the diagnosis without exposing the patient to radiation, prioritizing her safety. A successful surgery was performed to create a working vaginal canal. The patient received careful postoperative care, and we closely followed her progress to support a smooth recovery.

Frontal Meningoencephalocele With Cerebrospinal Fluid Rhinorrhea: A Case Report.

Traumatic brain injuries are a significant public health concern often associated with immediate consequences. However, delayed complications can manifest, including rare congenital neural tube defects such as encephaloceles. We present a case of a 45-year-old male with a history of traumatic brain injuries who developed a posttraumatic frontal meningoencephalocele associated with cerebrospinal fluid rhinorrhea. This case emphasizes the need for vigilance in assessing patients with a history of head trauma for delayed complications, even years after the initial injury. Early diagnosis and intervention can significantly impact outcomes.

A Case Report of Migraine With Hypoplasia of the Internal Carotid Artery.

Migraine, a widespread and incapacitating neurological disorder, affects numerous individuals worldwide, causing severe headaches and impairing their quality of life. The interplay of genetic, environmental, and neurovascular factors underlies the pathophysiology of migraine. This report highlights the case of a 25-year-old woman with recurrent, severe headaches, predominantly in the right frontal and temporal regions. She was diagnosed with migraine with aura, a diagnosis supported by her family history. No previous history of seizures was reported. A comprehensive work-up, including neuroimaging, revealed left internal carotid artery hypoplasia with compensatory collateral circulation. The coexistence of severe migraines and left internal carotid artery hypoplasia underscores the complex interrelationship between cerebrovascular anomalies and neurological symptoms. The rarity of this vascular variation emphasizes the need for attentive clinical evaluation and consideration of anatomical deviations in migraine patients. As medical knowledge progresses, further research is essential to unravel the mechanisms connecting vascular anomalies and neurological disorders, ultimately leading to personalized interventions for improved patient outcomes.

Assessment of Thyroid Dysfunction Among Pregnant Women With Pre-Existing Diabetes Mellitus or Gestational Diabetes Mellitus.

Objective This study investigates the prevalence and risk of thyroid disturbances in pregnant women with pre-existing diabetes mellitus (DM) or gestational diabetes mellitus (GDM) in a tertiary hospital setting in Riyadh, SA. This research's findings may help identify potential risk factors associated with thyroid disturbances during pregnancy and facilitate early diagnosis for at-risk pregnant women. Subjects and methods A retrospective cross-sectional study was conducted at an endocrinology clinic between October 2018 and December 2021 to evaluate the electronic records of pregnant women with DM or GDM who had documented normal thyroid function before pregnancy. Results Three hundred ninety-six files that met the selection criteria were deeply investigated and analyzed. The analysis showed that 378 (95.5%) patients were of Saudi nationality, and the mean age in years ± SD for the selected patients was 34.23 ± 5.468. The prevalence of obesity was 63.7%, with a mean body mass index (BMI) of 32.78 ± 6.78 kg/m2. The patients in this study were categorized into three groups based on their type of DM: 57 were diagnosed with type 1 DM (14.4%), 120 with type 2 DM (30.3%), and 219 with GDM (55.3%). The study identified 43 patients (10.85%) with subclinical hypothyroidism and 74 (18.69%) with hypothyroidism. Among the remaining patients, thyroid function was within the normal range for 264 (66.67%). The study also identified eight patients (2.02%) with subclinical hyperthyroidism and seven (1.77%) with hyperthyroidism. The prevalence of thyroid dysfunction was reported at 33.4%, with most of the dysfunction observed in the GDM group (20.7%). By comparison, the type 1 DM and type 2 DM groups presented a lower prevalence of thyroid dysfunction, accounting for only 4.1% and 8.6%, respectively. Conclusions Hypothyroidism, both clinical and subclinical, is more prevalent among patients with GDM than individuals with type 1 and type 2 DM. Research suggests a greater risk of developing hypothyroidism in patients with an increased BMI and among those older during pregnancy.

Factors associated with glycemic control and diabetes complications in a group of Saudi patients with type 2 diabetes.

Poor glycemic control is a risk factor for micro and macrovascular complications of diabetes. The aim of this study was to assess the prevalence and factors related to suboptimal glycemic control and diabetes complications in a group of patients with type 2 diabetes mellitus (T2DM). This cross-sectional descriptive study conducted in Al Qassim region, Saudi Arabia. Two hundred patients with T2DM were enrolled. Demographic, social, and self-care behavior data were collected. A thorough clinical evaluation was done. Glycated hemoglobin, lipid, and kidney profile results were recorded. Mann-Whitney test was used to compare different groups. For comparing categorical data, Chi-square (χ2) test was performed. Multivariate logistic regression analyses used to detect predictors of poor glycemic control and macrovascular and microvascular complications. The median age of patients was 58 years, and 62% of them were males. Only 22.5% of patients had glycated hemoglobin <7%. Forty-four patients (22%) had evidence of macrovascular complications. Retinopathy, neuropathy, and nephropathy were found in 42.5%, 32.5%, and 12%, respectively. Longer diabetes duration was significantly associated with poor glycemic control (OR = 1.006, P < .005). The age of the patients was independently associated with macrovascular complications (OR = 1.050, P = .029). Hyperlipidemia was significantly associated with neuropathy (OR = 0.229, P = .043) and retinopathy (OR = 12.887, P = .003). Although physical activity was lower in patients with suboptimal glycemic levels (P = .024), cardiovascular disease (P = .030), neuropathy (P < .001), retinopathy (P < .001), and nephropathy (P = .019), multivariate analysis showed that it was only independently associated with neuropathy (OR = 0.614, P = .001). The prevalence of suboptimal glycemic control is high in the studied population. Effective health measures are urgently needed to stop diabetes complications, especially retinopathy and neuropathy. Elderly people with long durations of diabetes, and lower physical activity should be the focus of the interventions. Tailored exercise programs are particularly needed for better diabetes control and for the prevention of complications in patients with T2DM.

Radiographic assessment of dental post and core placement at different educational levels in an undergraduate student clinic: a 4-year retrospective study.

Background: Dental post and core is one of the common procedures performed after endodontic treatment. The aim of this study was to radiographically assess the quality of post and core procedures performed by dental students at different education levels in addition to determining the most critical errors encountered during their clinical practice. Methods: A retrospective cross-sectional study design was conducted in the College of Dentistry, Imam Abdulrahman Bin Faisal University. A total of 550 periapical radiographs (PAs) of cemented posts were retrieved from the records of patients treated by dental students. Parameters and guidelines for assessing the quality of post treatment have been determined and statistically analyzed. A P value <0.05 was considered statistically significant. Results: The study included 502 students and most of them were females (66.5%). Data were obtained from 502 patients (62% females) with fiber posts used in 98.2% of the cases. About 50% of the posts were inserted in premolars, 62.9% in the upper arch, and 66.7% were restored with crowns as a final restoration. Regarding the quality of posts, 98.4% showed good preparation quality and 98% showed good radiographic quality. The post diameter was equal to 1/3 of the root diameter in 31.9% of the cases; post length was equal to 2/3 of root length in 5% of the cases and equal to or more than crown height in all cases (100%). Length of the remaining gutta percha (GP) was between 3-5 mm in 38.8%, and there was no gap between the post and remaining GP in 95.6% of the cases. There were no statistically significant differences between dental students at different clinical educational levels regarding the quality of post placement. Conclusions: The quality of post and core procedures performed by students showed acceptable radiographic quality and were within the recommended standards.

Knowledge, Attitude, and Behavior of Parents Regarding Early Childhood Caries Prevention of Preschool Children in Western Region of Saudi Arabia: A Cross-Sectional Study.

The knowledge and beliefs of parents have an impact on their children's general and oral health. The objective of this study is to assess knowledge, attitude, and behavior of parents and identify possible associated factors of early childhood caries (ECC) in the western region of Saudi Arabia. Parents aged 18 and older were invited to complete a self-administered, validated questionnaire. Questions covered demographics, knowledge, attitude, and behavior regarding ECC etiology and prevention. Of the 644 parents who completed the questionnaire, 51.4% were not aware of the early signs of tooth decay, such as white lines. Pain and trauma were reported as the major reasons for a child to visit a dentist (42.4%). Only 37% of parents were aware of the importance of fissure sealant, and only 23% knew how it is applied. Compared with mothers, fathers were significantly less aware of hidden sugar and the relation between the frequency of consuming breast milk or bottled milk and caries development (p = 0.001). Similarly, fathers were more likely to believe that children could achieve effective teeth cleaning without parental assistance (p = 0.001). Preventive guidance should be provided by oral healthcare providers in Saudi Arabia to improve parents' knowledge of ECC prevention.

The influence of obstructive sleep apnea on self-perceived dental aesthetics and need for orthodontic treatment among the general population in Makkah, Saudi Arabia.

OBJECTIVE: To assess the influence of obstructive sleep apnea on self-perceived dental appearance and need for orthodontic treatment. MATERIALS AND METHODS: A self-administered questionnaire was used in a random sample of a general adult population in Makkah region, Saudi Arabia. A total of 1014 participants completed the questionnaires, which included the STOP-BANG questionnaire, Oral Aesthetics Subjective Impact Score questionnaire, and Aesthetic Component of Index of Orthodontic Treatment Need questionnaire. Descriptive statistics and Chi-square tests were used to compare differences between the groups. RESULTS: Overall, 6.5% (66/1014) of the participants were classified as being at high risk of OSA of which 71.2% were males and 28.8% were females (P < 0.001), 57.6% were >50 years of age, 90.9% had obesity, and 81.8% had an enlarged neck circumference. But only 10.1% of the participants reported that they snore loudly. A positive self-perception of dental esthetics was found in 42 (6.2%) and 518 (76.6%) participants at high and low risk of OSA, respectively. Furthermore, of the participants in the high- and low-risk groups, 4.2% and 66.7% considered themselves in need of orthodontic treatment, respectively. CONCLUSIONS: The prevalence rate of people at intermediate to high risk of OSA was 26% of the general population and being at high risk of OSA had no influence on self-perceived dental esthetics and need for orthodontic treatment.

A Glance at the Development and Patent Literature of Tecovirimat: The First-in-Class Therapy for Emerging Monkeypox Outbreak.

Monkeypox disease (MPX) is currently considered a global threat after COVID-19. European Medicines Agency (EMA) approved Tecovirimat in capsule dosage form (200 mg) as the first treatment for MPX in January 2022. This article highlights Tecovirimat's development and patent literature review and is believed to benefit the scientists working on developing MPX treatments. The literature for Tecovirimat was gathered from the website of SIGA Technologies (developer of Tecovirimat), regulatory agencies (EMA, United States Food and Drug Administration (USFDA), and Health Canada), PubMed, and freely accessible clinical/patent databases. Tecovirimat was first recognized as an anti-orthopoxvirus molecule in 2002 and developed by SIGA Technologies. The USFDA and Health Canada have also recently approved Tecovirimat to treat smallpox in 2018 and 2021, respectively. The efficacy of Tecovirimat was verified in infected non-human primates (monkeys) and rabbits under the USFDA's Animal Rule. Most clinical studies have been done on Tecovirimat's safety and pharmacokinetic parameters. The patent literature has revealed inventions related to the capsule, injection, suspension, crystalline forms, amorphous form, and drug combinations (Tecovirimat + cidofovir) and process for preparing Tecovirimat. The authors foresee the off-label use of Tecovirimat in the USA and Canada for MPX and other orthopoxvirus infections. The authors also trust that there is immense scope for developing new Tecovirimat-based treatments (new drug combinations with other antivirals) for orthopoxvirus and other viral diseases. Drug interaction studies and drug resistance studies on Tecovirimat are also recommended. Tecovirimat is believed to handle the current MPX outbreak and is a new hope of biosecurity against smallpox or orthopoxvirus-related bioterrorism attack.

Development of a deep learning model for automatic localization of radiographic markers of proposed dental implant site locations.

Objectives: To develop a Deep Learning Artificial Intelligence (AI) model that automatically localizes the position of radiographic stent gutta percha (GP) markers in cone beam computed tomography (CBCT) images to identify proposed implant sites within the images, and to test the performance of the newly developed AI model. Materials and Methods: Thirty-four CBCT datasets were used for initial model training, validation and testing. The CBCT datasets were those of patients who had a CBCT examination performed wearing a radiographic stent for implant treatment planning. The datasets were exported in Digital Imaging and Communications in Medicine (DICOM), then imported into the software Horos ®. Each GP marker was manually labelled for object detection and recognition by the deep learning model by drawing rectangles around the GP markers in all axial images, then the labelled images were split into training, validation, and test sets. The axial sections of 30 CBCT datasets were randomly divided into training and validation sets. four CBCT datasets were used for testing the performance of the deep learning model. Descriptive statistics were calculated for the number of GP markers present, number of correct and incorrect identifications of GP markers. Result: The AI model had an 83% true positive rate for identification of the GP markers. Of the areas labelled by the AI model as GP markers, 28 % were not truly GP markers, but the overall false positive rate was 2.8 %. Conclusion: An AI model for localization of GP markers in CBCT images was able to identify most of the GP markers, but 2.8% of the results were false positive and 17% were missed GP markers. Using only axial images for training an AI program is not enough to give an accurate AI model performance.

Development of an optimized febuxostat self-nanoemulsified loaded transdermal film: in-vitro, ex-vivo and in-vivo evaluation.

Febuxostat (FBX) is used to treat gout and chronic hyperuricemia. However, its bioavailability is moderate (49%) as a result of low solubility and first-pass metabolism. Therefore, the aim of our study is to improve FBX bioavailability by enhancement its solubility using self-nanoemulsifying drug delivery system (SNEDDS) technique in the form of transdermal film to avoid hepatic metabolism. To accomplish this goal, Eight SNEDDS formulae were prepared according to a three-factor, two-level D-Optimal mixture design to evaluate the effect of different ratios of the Lemon oil (X1), the surfactant Tween-20 (X2), and the co-surfactant PEG-400 (X3) on the globule size in order to reach smallest globular size. Results revealed that SNEDDS globule size ranged from 177 to 454 nm. The optimized formula consisted of 20% oil, 40% surfactant and 40% co-surfactant. Diffusion study showed improved enhancement in skin permeation that was confirmed by imaging using fluorescence microscope. In vivo plasma data showed significant (p < 0.05) difference in FBX plasma levels and pharmacokinetic parameters when compared with raw FBX loaded film. In conclusion, FBX-SNEDDS loaded transdermal film could be a successful way to improve solubility and skin permeability that would lead to improvement in patient's compliance.